What is body dysmorphic disorder?
Body dysmorphic disorder (BDD), sometimes called body dysmorphia, is a type of obsessive-compulsive disorder1. People with BDD have a preoccupation with some aspect of their appearance (that nobody else may notice), which distracts them so much that they often can’t go about their normal daily activities.
Muscle dysmorphia is a form of BDD. People with muscle dysmorphia think their muscles are too small, even if they’re quite muscular. They might have obsessive dietary and exercise behaviours that dominate their day-to-day lives2.
BDD affects around 1 in 50 adults. It usually begins during the teenage years and gradually gets more severe3.
BDD is just as common in males as in females4, although muscle dysmorphia usually only occurs in males5.
Symptoms of body dysmorphic disorder
Lots of people with BDD don’t realise they have it3.
Common behaviours of people with BDD include:
- Spending hours each day grooming
- Picking at their skin or repeatedly touching the part of their body they are concerned about
- Constantly checking their appearance in a mirror, amounting to hours spent each day, or avoiding mirrors altogether
- Seeking reassurance about their appearance from other people
- Trying to hide the part of their body they are concerned about, with things like makeup, clothing or their hair
- Excessive exercise
- Comparing their appearance with others
- Seeking help to change the appearance of the part of their body they are concerned about, for example, through cosmetic surgery.
Causes of body dysmorphic disorder
We don’t fully understand why some people get BDD and some don’t, but genetic, psychological and social factors probably all contribute6.
BDD is more likely than usual to occur in people who have a mother, father, sister or brother with the disorder, who have experienced childhood trauma, or who are from minority groups.
Diagnosis of body dysmorphic disorder
Most people with BDD don’t get diagnosed7, often because they don’t realise they have a problem.
BDD is a psychological diagnosis based on the following criteria:
- Constantly thinking or being concerned about one or more problems with your appearance, which are not noticed by other people
- Repetitive behaviours or thoughts related to the concerns about your appearance (e.g. skin picking, comparing your appearance to others)
- Being distressed by your appearance or being unable to go about normal activities (e.g. work, social activities)
- Having an eating disorder that can’t be explained by concerns about weight or body fat.
Treatment of body dysmorphic disorder
The behaviours associated with BDD can be reduced by seeing a psychologist or psychiatrist for cognitive behavioural therapy, sometimes in combination with medication.
Getting cosmetic treatment for the part of your body that worries you will most likely not relieve your concerns.
Health effects of body dysmorphic disorder
BDD can last your whole life, and the psychological effects it has during your teenage years can have lasting consequences for how you think and act4.
Males with BDD are more likely than normal to have anxiety, depression, emotional and behavioural problems, relationship troubles, hyperactivity and low quality of life4. When these problems occur during your teenage years, they can have long-term consequences for your social, romantic, educational and working life4.
What to do about body dysmorphic disorder
If you answer yes to most or all the questions below, you should talk to your doctor.
- Are you concerned about some aspect of your appearance?
- Do you spend a lot of time worrying about some aspect of your appearance?
- Do you spend a lot of time trying to hide physical defects?
- Do you think you are malformed, misshapen or disfigured in some way?
- Do you think your body functions in an offensive way (e.g. bad body odour, flatulence, sweating)?
- Has anyone told you that you look normal, even though you know something is wrong about your appearance?
- Have you felt like you need to see a medical specialist (e.g. cosmetic surgeon, dermatologist) to correct a problem with your appearance?
- Do you feel the need to change your appearance in photos by using apps (like Facetune) or filters (like in Snapchat)?
Listen to the people who are close to you if they tell you they are concerned about you. It might be worth seeing a doctor to rule out the condition, rather than living with a problem you can’t see, that could be treated.
What questions should I ask my doctor about body dysmorphic disorder?
- Can you see the problem with my appearance that I am concerned about?
- Why do you think I have concerns about my appearance?
- Can you recommend someone I can speak to about my concerns with my appearance?
- How can talking to someone about my concerns help?
1. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR). 2002, American Psychological Society
2. Rohman, 2009. The Relationship Between Anabolic Androgenic Steroids and Muscle Dysmorphia: A Review. Eating Disorders
3. Phillipou & Castle, 2015. Body dysmorphic disorder in males. Australian Family Physician
4. Schneider et al., 2017. Prevalence and correlates of body dysmorphic disorder in a community sample of adolescents. Australian & New Zealand Journal of Psychiatry
5. Malcolm et al., 2021. An update on gender differences in major symptom phenomenology among adults with body dysmorphic disorder. Psychiatry Research
6. Nicewicz & Boutrouille, 2022. Body Dysmorphic Disorder. StatPearls https://www.ncbi.nlm.nih.gov/books/NBK555901/
7. Schulte et al., 2020. Treatment utilization and treatment barriers in individuals with body dysmorphic disorder. BMC Psychiatry